Health Coverage Disparities Eliminated Under ACA for Most Racial Groups, Report Finds

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African Americans, Asians and Pacific Islanders living in California are just as likely to have health insurance as whites, marking a significant turnaround from five years ago, new data shows.

The report, based on survey data from the UCLA Center for Health Policy Research, shows the uninsured rate for all racial and ethnic groups other than Latinos hovering between 4 and 7 percent in 2017, a statistically insignificant difference. That compares to 2013, when African Americans, Asians and Pacific Islanders were almost a third more likely than whites to be uninsured.

Analysts attributed the change to California’s implementation of the Affordable Care Act in 2014, which has expanded health care coverage to more people, largely by widening eligibility for Medi-Cal and providing insurance subsidies for people with low to moderate incomes.

“This is a level of equity in terms of health insurance coverage that we haven’t seen before, so it really does represent tremendous progress for California,” said Amy Adams, a senior program officer with the California Health Care Foundation. “At the same time we need to address the lagging uninsured rate among Latinos.”

Although the uninsured rate for Latinos has dropped by half since 2013, this population is still almost twice as likely to be without health insurance as other ethnic and racial groups. In 2017, more than 12 percent of Latinos were uninsured, compared to 8.5 percent of the state’s population as a whole.

UCLA researcher Tara Becker said the disparity is likely because a greater proportion of Latinos are non-citizens and don’t qualify for Medi-Cal or insurance subsidies. Language difficulties may also play a role, she said, possibly leading more Latinos to lack awareness of the benefits available to them.

Expanding Medi-Cal eligibility to undocumented adults would help bring the uninsured rate down among Latinos, Becker said. The state already allows undocumented children to enroll in Medi-Cal as of 2016.

Adams said decreasing the uninsured rate among Californians benefits the entire state.

“It means fewer Californians die early, fewer Californians miss work due to illness, go bankrupt or have to forgo other necessities because of medial bills,” she said. “People who are covered are more likely to get their care earlier so their medical conditions don’t become more serious and expensive. And in terms of thinking about how insurance works, having as many people covered as possible helps keep premiums down for everyone.”

Overall, the uninsured rate stayed constant at 8.5 percent from 2016 to 2017. That’s down from almost 16 percent in 2013. Becker said the leveling off could be due to public uneasiness and confusion over the future of the Affordable Care Act amid federal efforts to undermine it.

“It could be that the uncertainty of the policy environment slowed gains we would otherwise have had,” Becker said. “It also might be that we’re reaching the maximum of what the Affordable Care Act can do on its own.”

Still, expanding Medi-Cal eligibility and providing more financial assistance to moderate-income people buying private health insurance plans could further help coverage rates, Becker and Adams agreed.

“In 2017, what we saw in the report was that the one group that does seem to be seeing slight increases from year to year is the sort of higher-income population, those whose incomes make them ineligible for subsidized coverage and for Medicaid,” Becker said. “Any increases in premiums are going to be disproportionately felt by that group. So efforts to reduce costs would obviously help them, as would expanding subsidized coverage or something like that to that population.”

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